Myth: People only become transgender when they transition

People are transgender as long as they have a gender identity that’s at odds with their birth-identified sex, regardless of whether they have taken any steps to socially or medically transition. A transgender man is a man even if his body still looks female and he lives as a woman, just like how a cisgender man who gets castrated or who puts on a dress is still a man. Gender identity is not defined by how you dress or what body parts you have.

Myth: Transitioning makes people suicidal

Transgender people do have a vastly elevated risk of suicide. A large survey from 2011 revealed 41% of American transgender people still alive had attempted suicide at least once in the past, vs. the US national average of 1.6%. An oft-quoted study (Dhejne et al., 2011) similarly reports that the suicide rate for transgender people who had undergone sex reassignment surgery (SRS) prior to 1989 was about 20 times that of the general population.

Some people thus claim that transition or surgery makes people suicidal. This is a misinterpretation of the data, because it compares transgender people who have transitioned with the general population, rather than with transgender people who have not transitioned.

The study itself clarifies: “The results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”

The study’s author herself, Ceceilia Dhejne, denounced this misinterpretation of her workand reiterates that she strongly supports transition for trans people, citing the numerous sources supporting its benefits. She also pointed out that the elevated suicide rate applied only to those who had transitioned prior to 1989; those who transitioned between 1989 to 2003 had no such increased risk.

It is expected that transgender people would have a higher suicide rate, due both to the internal distress from gender dysphoria as well as external abuse. Society is largely hostile to transgender people. A majority report having experienced verbal, physical or sexual assault for being transgender, where this may be on-going in case of youth living with unsupportive family. Many also get disowned, fired from jobs and made homeless, resulting often in poverty, elevated risk of mental illness and drug abuse, all of which are factors correlated with suicide risk.

The 2011 survey linked above included factors that raised the suicide attempt rate among trans people: those who lost a job due to bias (55%), were harassed/bullied in school (51%), were the victim of physical assault (61%) or sexual assault (64%).

It would thus be more surprising if the transgender suicide rate was not vastly higher than that of the general population – which was in fact the case for transitioned transgender men in that very same Swedish study, who had similar suicide rates as female controls. As a whole, trans women receive greater abuse from society than trans men, which would explain their higher suicide rate.

UK study: “Suicidal ideation and actual attempts reduced after transition, with 63% thinking about or attempting suicide more before they transitioned and only 3% thinking about or attempting suicide more post-transition. 7% found that this increased during transition, which has implications for the support provided to those undergoing these processes (N=316).”

Kuiper, 1988: Dr. Ryan Gorton: “In a cross-sectional study of 141 transgender patients, Kuiper and Cohen-Kittenis found that after medical intervention and treatments, suicide fell from 19 percent to zero percent in transgender men and from 24 percent to 6 percent in transgender women.) … a significant proportion of the drivers of suicide in the LGBT population as a whole is minority stress.”

(Note: While some of the studies mention that their data is of low quality, this has to do with the inherently subjective nature of reports of suicidal thoughts or attempts, as well as the lack of controls, which would be unethical as it would require deferring treatment and waiting to see which subjects kill themselves. However, the largest study to date on the lifetime suicide attempt rate of the general trans population places it at around 40%. The fact that these studies of medically transitioned trans people show rates significantly under 40% (and none above) thus support the positive impact of transition.)

Supportive family also makes a big difference. In a 2012 study of 433 transgender youth, those who had parents who were supportive of their identities and transition reported only a 4% attempted suicide rate, vs. 57% for those with unsupportive parents.

In fact, transgender youth who underwent medical intervention at puberty were found to score similar or better on measures of mental well-being, compared to their non-trans peers (deVries et. al, 2010).

In short, while transgender people have a significantly higher rate of suicide than people who aren’t trans, the most effective way to lower this rate is to allow them to transition.

Myth: Transitioning doesn’t treat the root of the problem and worsens mental health

The opposite is true – the longer gender dysphoria goes untreated, the more likely the person is to develop mental illnesses with time. Transitioning is on the other hand associated with improved mental functioning over multiple measures:

Ainsworth & Spiegel, 2010: Transgender women who had undergone relevant surgeries were found to have mental health scores comparable to women in general, while those who were not able to access care scored much lower on mental health measures.

Asscheman, 2014: Reduction in depression from 24.9% to 2.4% for trans women, and 13.6% to 1.4% for trans men.

Heylans et al., 2014: The most prominent decrease in measures of distress, anxiety and stress was observed upon the initiation of hormone therapy, after which scores resembled that of the general population.

Colizzi et al., 2013: At enrollment, subjects experienced highly elevated levels of CAR (cortisol awakening response – a physiological measure of stress) as well as higher levels of perceived stress. One year after hormone therapy was initiated, CAR levels and reports of perceived stress had both fallen to within normal range.

Gomez-Gil et al., 2012: Scores of depression and anxiety were significantly higher on untreated patients compared to those who had begun cross-sex hormone treatment; symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33%, and 31% vs. 8% respectively).”

Right now, there are over 136 such studies reporting such improvements in mental health as a result of medical intervention for transgender people. Some of those are collected here:

Myth: Transgender people are just self-hating gays

Even if this were true, it would only account for about one third of transgender people, given that the rest are either bisexual, asexual, or transition into being perceived as gay when they would have been ‘straight’ as their birth sex. Transgender people come in all sexual orientations, and are much more likely, in their post-transition identities, to be LGB.

One cannot argue that social homophobia is pressuring masses of feminine gay men to transition to supposedly easier lives as feminine straight women, when masses of people originally perceived as feminine straight women are transitioning to live as feminine gay men, apparently undaunted by that very same social homophobia.

In addition, society is still largely more hostile towards transgender people than gay people, such that someone who transitions in order to escape homophobia would basically be jumping out of the frying pan and into the fire.

Myth: Most people regret transitioning / surgery

This is untrue. The regret rate for sexual reassignment surgery ranges from about 0-2% as reported by most recent studies on the subject.

(For comparison’s sake, the regret rate after cosmetic surgery hovers at around 65% in the UK, but it has not received anywhere near the same level of public moral concern.)

Dhejne, 2014: Among the 767 transgender people in Sweden who transitioned from 1960-2010, the overall regret rate for sex reassignment surgery was 2.2%. This figure was observed to steadily decrease over the years as medical techniques improved (leading to fewer health complications) and social acceptance grew. The author also notes that some cases were due to patients feeling pressured into unwanted surgery so as to be able to change their legal sex.

de Cuypere, 2006: Among 107 trans people who underwent SRS in Belgium from 1986-2001, they found zero regrets.

Michel, 2002: Among trans people in France, the regret rate for SRS was under 1%.

Smith, 2005: A study of 162 trans people who underwent SRS had 2 patients who cited regrets (1.2%). Both were transgender women who were not attracted to men, and who suffered mental health problems and low levels of body satisfaction – all of which impeded their ability to blend into society.

Among those who did regret surgery or transition, as well as those who detransitioned, commonly cited reasons include:

Inability to cope with the abuse from family, friends and society that they experienced as a result of transitioning; being subject to homelessness, poverty, unemployment, assault; loneliness, especially the difficulty in developing romantic relationships

Changing political or religious views on gender, particularly regarding the validity/morality of transgender identities and transitioning

Misdiagnosis – either due to a mental illness which confounded the results, or a case where gender non-conformity was mistaken for a transgender identity

Attributing their dysphoria to past trauma (especially sexual abuse or the fear of such) or internalised misogyny, rather than a genuine identification with or desire to be another sex; in some cases, trauma counselling solved the dysphoria

Internalised transphobia, e.g (“I’ll never be a real woman”) and finding it preferrable or more honest to struggle with dysphoria than live as a transitioned transgender person

Mistaking a desire not to be their assigned sex for a desire to be the other sex

Realising they were actually non-binary, and just as uncomfortable with a body more typical of the ‘other’ sex

Having felt pressured into transition or into taking transition steps they did not want, especially surgery. Some had not desired sex reassignment surgery in the first place (perhaps due to cost, disatisfaction with current technology, lack of genital dysphoria, a desire to retain fertility, etc) but were pressured into doing so by doctors, gendered body ideals or romantic/sexual partners, or as a requirement to change legal sex (as is currently the case in Singapore)

Sadness at loss of fertility, due to wanting to have their own biological children

Poor or disatisfactory surgical outcomes (which is becoming less common as technology continues to improve; the risk of complications for MTF genital surgery is now down to 1%)

Inability to ‘pass’ as cisgender, leading to diminished quality of life and fears for safety

Frequently, straight transgender people also report much better outcomes than those who have to navigate life as an LGB person after transitioning, due to the impact of social homophobia.

Among misdiagnosed cases, the most notable is Walt Heyer, who suffered from undiagnosed Dissociative Identity Disorder due to childhood trauma. One of his multiple personalities was that of a woman. He was wrongly diagnosed as transgender, whereupon he was encouraged to pursue sex reassignment surgery he did not actually want. He underwent the surgery but found it extremely traumatic. He sued the doctors who treated him for malpractice and is convinced that because they were wrong in his case, no transgender person should be allowed to transition. He now actively advocates against transitioning, citing himself as an example of regret, despite not being anywhere near representative of a typical transgender person.

Another well-known case is that of Sam Hashimi, a rich property tycoon who suffered a mental breakdown after he broke up with his wife. In his mid-life crisis that followed, he decided that women had it easier in life and he wanted to be one. His wealth and connections allowed him to bypass a lot of the usual obstacles to transitioning and get what he wanted, only to find himself responding badly to hormone therapy and growing increasingly depressed and dysphoric at living as a woman. He thus detransitioned back to living as male. His story is also far from representative of transgender people who transition out of rather than into gender dysphoria, and who are motivated by the need to express their gender identity.

There are a few cases where those who detransitioned found that things were not much better, or to find their gender dysphoria returning – sometimes resulting in them re-transitioning all over again. Some of them were willing to tolerate this, especially if the detransition was due to political or religious beliefs that considered transitioning a cop-out or a sin.

Others detransitioned because they decided that they were more comfortable as their original assigned sex. Not all of them consider this detransition, but rather a further step in aligning their bodies with their self-image. Some still identify as transgender, while others are happy with their bodies and have returned to identifying as their assigned sex.

We advocate that everyone who is considering transition first see a qualified counsellor and carefully consider your motivations for desiring transition. Here are some questions you may wish to ask yourself.

Myth: Johns Hopkins doctors discovered that medical transition harmed rather than helped transgender people and thus stopped providing such services

While it is true that Johns Hopkins temporarily stopped providing transition-related healthcare to transgender people, this was largely the action of their director at the time, Dr. Paul McHugh – a fundamentalist Catholic with religious rather than medical objections to transgender people. Many of the points he raised to support his view are debunked on this page – for instance, that allowing transgender people to transition increases suicide risk and worsens mental health.

Johns Hopkins has since distanced themselves from his views and spoken out against them. They have also resumed providing transgender healthcare and surgeries.

Myth: Transgender people cannot know for sure what gender they are until they hit puberty / 18 years old

One reason many people believe this is that they wrongly assume gender identity is a by-product of sexuality. This also sometimes leads to accusations that any child who expresses a transgender identity must have been sexually abused. This is not true. Gender identity exists independent of sexuality. Children do not need to know what sex or sexual attraction is in order to tell you if they’re a boy or a girl.

Gender identity in humans forms around the age of 3. Many transgender adults were aware of having an atypical gender identity from early childhood, even if they may not have had the words for it. But, just as most children are able to tell you if they are a boy or girl long before they reach puberty, so do many transgender children. The only difference is that their expressed gender identity may differ from what’s typical for their body type, and they may find their bodies distressing as a result.

A 2015 study exploring subconscious gender identity in children found that transgender children experienced their gender identities in ways indistinguishable from their non-trans peers. In other words, a transgender girl ‘feels’ like a girl in the exact same way other girls do.

Other transgender children may not experience as severe gender dysphoria, or be afraid to say anything, or be unaware that it is possible to be a gender other than what their bodies suggest. They may not understand themselves to be transgender until much later in life, but that is not a result of them changing their gender identity so much as taking a longer time to discover it.

Regardless, even if a transgender child may be unaware of the complex nuances of what being a particular gender means, they are able to tell when something feels wrong or causes them distress. There is no harm in taking steps to alleviate that distress, especially when it is prolonged and consistent; refusing to take action often leads to worse outcomes.

Myth: The vast majority of transgender children cease to be transgender in adulthood

In discussions of transgender children, particularly those who are transitioning, people often bring up the claim that 75/80/90/98/99.8% of transgender children will not grow up to become transgender adults, and hence are against letting them transition in childhood for fear of setting them onto a path that could otherwise be avoided.

However, the studies that these statistics came from studied small sample sizes of children who had been diagnosed with Gender Identity Disorder (GID) in the 80s and 90s. At that time, the diagnostic criteria primarily defined GID children as those who expressed a strong pattern of gender-atypical play and interests. It did not always require children to claim to be or desire to be the other sex – meaning that the a good number of children in those studies were merely feminine boys and masculine girls, whose expressed unhappiness with their gender had more to do with the ill-fitting expectations placed on them because of it.

This is one of the studies often cited as evidence. The study followed 25 girls, of which only 15 met the diagnostic criteria for GID; the remaining 10 were considered ‘sub-threshold’ cases. At follow up 14 years later, only 3 of the 15 were found to be transgender. However, most if not all of these girls would have been originally diagnosed under the DSM-III or IV, the former of which described GID in girls as follows:

Girls with this disorder regularly have male peer groups, an avid interest in sports and rough-and-tumble play, and a lack of interest in playing with dolls or playing “house”.

While (unlike the DSM-IV) the DSM-III required that children also express a strong, persistent desire to be the other sex, it is not very surprising that many tomboys would have expressed a wish to be a boy, given the much more rigid gender stereotypes back then. This paper detailed a case study (page 6) of a young girl who was insistent on wanting to be a boy and had met all the DSM-IV diagnostic criteria for GID. But when asked why she wanted to be a boy, she said it was because she liked boy’s underwear; she said that girls couldn’t wear boy’s underwear, so she wanted to be a boy.

Likewise, a boy who is told that he can’t play with dolls because only girls do that might react with: “then I want to be a girl!” However, his actual desire here is to play with dolls, not to actually be a girl, and the diagnostic criteria did not distinguish between the two.

Other studies follow a similar pattern. Meanwhile, many transgender children did not qualify for a diagnosis because they weren’t deemed masculine or feminine enough.

Partly to filter out these false positives, the diagnostic criteria were later revised to de-emphasise gender-atypical traits and place the focus instead on the persistent insistence that one was or wanted to be another gender, which is the defining feature of a transgender identity. This is especially so when this is accompanied by clear distress that stretches out over a long period of months or years. If a female child expresses a strong desire to be male, and this distress and desire abates when allowed to play with ‘boy’ toys and wear more masculine clothes, it’s likely that she is just a tomboy; however, if all those actions still fail to resolve the distress, chances are that this is a transgender boy.

Myth: Being transgender is the result of bad parenting

It is common for parents to blame themselves or feel guilty upon learning that their child is transgender, and to try and figure out what they might have done ‘wrong’ for their child to end up this way. However, there is no known correlation between parenting styles and gender identity, where the evidence currently points strongly towards biological – particularly hormonal – influences during pre-natal development.

Some parents worry that they were too strict in enforcing gender roles, resulting in a child that felt they had to be another gender in order to freely be themselves. Conversely, other parents worry that they weren’t strict enough in enforcing gender roles, resulting in a child whose gender-atypical behaviour wasn’t stamped out before it could develop into a transgender identity. For every parenting style, there are parents who did the exact opposite and still ended up with a transgender child. Trans people come from families that are conservative and liberal, religious and non-religious, rich and poor, loving and abusive, across all classes and races and cultures.

There is some weak evidence that being transgender runs genetically in families. It is not uncommon for more than one sibling to be transgender, or for a parent to eventually come out as transgender after their child does so, admitting that they had been repressing it all these years. Multiple members of an extended family may turn out to be transgender, even those who had no idea the others existed. There is also some link to non-heterosexual orientations, where trans people are more likely to have family members that are LGB; one trans woman discovered that all three of her sons from a previous marriage were gay.

Myth: Leading American pediatricians have declared letting children transition to be child abuse

A statement from the official-sounding American College of Pediatricians (ACPeds) refuted the legitimacy of transgender identities and declared that letting transgender children transition was child abuse.

However, unlike the American Academy of Pediatrics, which has a membership of over 64,000 pediatricians, the ACPeds is not an official medical institution, and is instead a small fringe group of about 60-200 people that was established with the explicit goal of pursuing an anti-LGBT agenda.

You can read a point-by-point debunking of their points in this article. Snopes also debunked their claims, along with a presentation from the actual American Academy of Pediatricians supporting an affirming approach to gender non-conforming children. They advise that parents provide their child with an accepting, supportive environment that will best let them thrive as they are, regardless of whether or not they turn out to be transgender.

For those who continue to assert a cross-sex identity and express a desire to transition, the AAP notes the positive outcomes in transgender children allowed to socially transition:

In sum, we provide novel evidence of low rates of internalizing psychopathology in young socially transitioned transgender children who are supported in their gender identity. These data suggest at least the possibility that being transgender is not synonymous with, nor the direct result of, psychopathology in childhood. Instead, these results provide clear evidence that transgender children have levels of anxiety and depression no different from their nontransgender siblings and peers.

Myth: Transgender women commit sexual assault at a similar rate as cisgender men

In the same 2011 study referenced earlier on this page, researchers found that transgender men and women in Sweden who transitioned from 1973-1988 had a similar rate of criminal convictions (including for violent crime) as cisgender male controls.

This data has been twisted to claim that transgender women rape other women at a similar rate as men, and should thus be prevented from accessing female spaces for safety reasons. This is a complete misinterpretation of the study. (It also does not explain why such people are often fine with having transgender men in female spaces, given that they also exhibited the exact same crime rate. If, as some people claim, this proves that transgender women are ‘really’ men, then by that same logic it would prove that transgender men are really men – which they don’t believe.)

As clarified by the study’s lead author, Cecilia Dhejne, the study did not account for different conviction types but referred to number of convictions for crime in general. There is no way to know what the statistics were for a specific crime such as rape.

Other factors that further complicate the data include:

Crime often correlates strongly with poverty, homelessness and unemployment, all of which disproportionately affect transgender people. It is thus expected that there would be a higher incidence of related crimes such as robbery, theft, prostitution and drug abuse, which would naturally inflate the crime rate.

Related to the above, poorer areas are often more heavily policed, leading to a higher rate of arrests and convictions than areas with a lower police presence.

Due to discrimination, lack of social power and increased visibility, transgender people might be more likely to get arrested and convicted for crimes, especially if the system is corrupt.

More importantly, the study states that no such elevation in crime rates was observed in transgender people who transitioned from 1989-2003. The researchers ascribe this to improved physical and mental health care, and greater social acceptance of transgender people in Sweden.

Whereas if it were true that transgender women were inherently more prone to crime due to being ‘really’ men, it would not explain why these elevated rates were only observed in those who transitioned before 1989 – after which they exhibited similar crime rates as cisgender female controls.

Transgender men already have some male privilege by virtue of being men and looking at the world from that perspective, although this is tempered both by transphobia and when not perceived by others as men.

In transitioning and giving up the ability to pass as cis women, transgender men also lose cis-passing privilege (and in some cases straight privilege), which often puts them in a worse social position than before.

Even if it’s considered morally better for trans men to not transition and suffer in solidarity with women, it would be a double standard if we don’t then expect cisgender men to transition to female to do the same. That would in fact be the more logical choice if the goal is indeed to reduce cumulative male privilege, which cis men have the most of and benefit the most from. Meanwhile, nothing less than full support of trans women would make sense, which makes it paradoxical that those who subscribe to this view are also often against trans women.

Lastly, if women were indeed transitioning just to escape misogyny and sex-related trauma (such as rape), it says a lot about society’s treatment of women that it would drive them to those extremes. The focus should then be on fixing society, not on further victimising those who are merely trying to escape; that would be addressing the symptoms of a problem, not the root.

Surely the best course of action would be to work to make society better for women and see if this reduces the number of trans men. Insisting instead that they should suffer – even if being female distresses them to the point of wanting to kill themselves, when they could instead live happy, fulfilling lives as men who would be much better placed to work alongside women for equality – would be both cruel and counterproductive. It would also position womanhood as punishment and manhood as freedom that is gifted solely to those born with it. Political ideologies should not be enforced at the cost of human lives, especially when doing so results in no conceivable good.

Myth: Transgender people do not want to be treated as men or women, but a separate gender

Generally speaking, transgender men wish to be treated like other men, and transgender women like other women, with the corresponding pronouns and modes of address.

Another subset of transgender people are currently known as non-binary, and do not identify as men or women. Their desire to be seen as a separate gender (or a mix, or neither) is due to being non-binary, not due to being transgender.

Transgender people who actively identify themselves as trans do so in addition to rather than instead of being men, women or non-binary, much like how someone might describe themselves as both Malay and a woman.

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